CommercialAdministrativeMedium impact
New Provider Coding Education Program, Provider Scope
BlueCross BlueShield of South Carolina·SC·Claims
Effective date
Apr 3, 2026
We identified it
Aug 11, 2026
Summary
BlueCross BlueShield of South Carolina is launching a new Provider Scope® Education program in partnership with Codoxo to monitor provider coding patterns using AI and rules-based analysis. Providers will receive education on billing practices and coding compliance, with potential for future prepay or post-pay audits if patterns are not addressed. No immediate operational changes are required, but providers should register for portal access to review their billing activity.
Action Required
By April 3, 2026: All providers and billing staff should register for access to the Codoxo Provider Scope® portal to monitor coding patterns and receive education. Billing team and rendering practitioners must provide registration information to Codoxo including: Billing Provider Name or Rendering Practitioner's Full Name, NPI, Tax ID, phone number, email address, mailing address, and fax number. Proactively review billing activity and coding patterns in the portal when access is granted to identify any patterns that could trigger audits. Billing team should monitor for communications from Codoxo (letters, emails, phone calls) regarding coding patterns and coordinate with clinical staff to address any identified issues. Failure to address flagged billing patterns may result in prepay or post-pay audits. For questions, contact Codoxo at 470-223-3591.